The Centers for Medicare & Medicaid Services (CMS) has delayed the implementation of its updated surveyor guidance to March 24, 2025. This move gives nursing homes additional time to prepare for the significant changes to how surveyors will assess compliance with key regulations.
Originally slated to take effect in February, the new guidance, detailed in Appendix PP of the State Operations Manual, was pushed back due to its extensive nature. The revisions impact a wide range of areas, including staffing, antipsychotic medication use, discharge planning, and infection control.
“My assumption about the delay is that they don’t have the surveyors fully trained and ready to go yet,” says Brandie N. Elizaitis, director of operations and consultant for the CMS Compliance Group. “Releasing additional guidance in mid-January to be effective at the end of February may have been too optimistic of a timeline for this many changes and the associated training needed.”
Key Changes in the Updated Guidance:
- Increased Scrutiny of Psychotropic Drug Use: The guidance includes stricter criteria for the use of antipsychotic medications, emphasizing that they should be a last resort. Surveyors will be looking for clear documentation of the clinical rationale for prescribing these medications and evidence of resident consent.
- Focus on Staffing Levels: Surveyors will now use Payroll-Based Journal (PBJ) data to assess staffing levels before on-site inspections. This change aims to provide a more accurate picture of staffing adequacy and ensure compliance with minimum staffing requirements.
- Enhanced Discharge Planning: The guidance strengthens requirements for discharge planning, emphasizing the importance of resident involvement and ensuring a smooth transition to the next care setting.
Impact on Nursing Homes:
The delayed implementation gives nursing homes valuable time to review the updated guidance, train staff, and adjust policies and procedures to ensure compliance.
“The obvious upside with the latest update is that it gives providers more time to ensure they can comply,” says Elizaitis.
However, the delay may be short-lived. A regulatory freeze initiated by the Trump administration could further postpone the implementation of the guidance.
Industry experts are urging nursing homes to use this time wisely to prepare for the changes.
“There is definitely a theme throughout the guidance that I read regarding psychotropic medications, and that is that psychotropic medication should be the last resort,” says Lori Walsh, policy and program specialist for The National Consumer Voice for Quality Long-Term Care.
The updated guidance represents a significant shift in CMS’s approach to nursing home oversight. By focusing on key areas like staffing and medication use, CMS aims to improve the quality of care and quality of life for nursing home residents.